New findings from the ISCHEMIA trial suggest that spontaneous heart attacks significantly reduce patients' quality of life (QoL) both immediately and long after the event. The research found that spontaneous myocardial infarctions (SMI) was linked to notable declines in both generic and disease-specific quality of life early and late after the event, when compared to procedural myocardial infarctions (PMI). In contrast, the research team, led by Mario Gaudino, MD, PhD, from Weill Cornell Medicine in New York, found that PMI had only a brief impact on disease-specific symptoms. ISCHEMIA trial "In the ISCHEMIA trial, SMI was independently associated with subsequent worsening of both generic and disease-specific QoL within and beyond 3 months after the event," the paper’s authors wrote. "Conversely, PMI was not associated with changes in generic QoL and was associated only with a transient decrease in disease-specific QoL." The investigation, which is published in JACC Cardiovascular Interventions, randomized 4,375 patients, where a total of 84 PMIs and 352 SMIs occurred. SMI was associated with significant decreases in both early (adjusted difference -5.7; 95% confidence interval [CI]: -7.3 to -4.1 points) and late European Quality of Life-5 dimensions visual analogue scale (EQ-5D VAS) (-3.1 points; 95% CI: -4.3 to -1.9 points). SAQ-7 decreases “Improving quality of life is often more important for patients than preventing discrete cardiovascular events, including MI,” the team explained. “QoL is measured using continuous scales that greatly improve statistical power to evaluate this association.” The study concluded that clinical trials and treatments should consider how different types of heart attacks impact patient well-being, not just survival rates. The researchers call for further studies to determine which kinds of spontaneous heart attacks most significantly impair quality of life. Methodology The study analyzed data from the ISCHEMIA trial comparing invasive (INV) versus conservative (CON) treatment strategies in patients with stable coronary artery disease. In total, 4,375 patients were randomized to INV or CON arms. Patients had at least one follow-up QoL assessment. The median follow-up was 36.2 months. The primary analysis was a linear, repeated-measures, multivariable-adjusted, mixed-effects model, with a random intercept for patient. QoL assessments occurring <3 months after MI were defined as early QoL and those occurring >3 months after MI were defined as late QoL. Source: Gaudino M, Stone GW, Heise RS, et al. Association between myocardial infarction and quality of life in the ISCHEMIA trial. JACC Cardiovasc Interv. 2025 April 28 (Article in Press). Image Credit: Alexis S/peopleimages.com – stock.adobe.com